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Gender equity and intimate partner violence among adolescents and young adults in Tanzania.
Get PDFIntimate partner violence (IPV) starts at a young age. In Tanzania, 32% of adolescent girls and young women report lifetime experience of physical or sexual IPV. Adolescence is a critical developmental period when young people are establishing beliefs around gender equity and violence and when programmes and interventions may be most influential. This study explored adolescent and young adult perspectives on gender equity and gender roles, and their links to IPV to inform the adaptation and implementation of an evidence-based gender empowerment curriculum for young people in Tanzania. We conducted 24 focus group discussions among young people ages 14-24, adult community members, and community and religious leaders. Five major themes were developed: social acceptance of traditional gender roles and male dominated families; generational divide on support for gender equity; a religious lens on gender equity and the tolerance of violence; the normalisation of violence; and recommendations to promote gender equity. Our findings suggest young people, particularly girls and young women, support gender equity concepts. However, pervasive social norms about traditional gender roles, perpetuated by adults and community leaders, inhibit gender equity. Recommen-dations included involving peers, family, and wider community in gender empowerment education; and engaging religious leaders
Small for gestational age subgroups have differential morbidity, growth, and neurodevelopment at age 2: the INTERBIO-21st Newborn Study.
Get PDFBACKGROUND: Small for gestational age is a complex perinatal syndrome associated with increased neonatal morbidity, mortality, and impaired childhood growth and neurodevelopment. Current classifications rely primarily on birthweight, which does not capture the heterogeneity of the condition nor predict long-term health outcomes. Here we aim to identify and characterize distinct small for gestational age subgroups and assess their neonatal and early childhood health trajectories. OBJECTIVE: To refine the classification of small for gestational age by identifying subgroups based on maternal, fetal, and environmental factors and evaluating their associations with neonatal morbidity, growth, and neurodevelopment at age 2. STUDY DESIGN: Prospective cohort study. In six countries worldwide, between 2012 and 2018, the INTERBIO-21st Study enrolled small for gestational age and non-small for gestational age newborns defined by the <10th centile of international standards with moderate (≥third-<10th centile) and severe (<third centile) small for gestational age subgroups; we assessed their growth, health, nutrition, motor development, and neurodevelopment up to age 2. We used 2-step cluster analysis to identify small for gestational age subgroups, and a probabilistic approach to choose the optimal subgroup model based on a statistical measure of fit. We performed logistic regression analysis (odds ratio; 95% confidence interval) to assess health and development outcomes among subgroups using the non-small for gestational age as reference group, adjusting for key confounders. RESULTS: We enrolled 5153 non-small for gestational age and 1549 small for gestational age newborns: moderate (≥third-<10th centile) small for gestational age=947 and severe (<third centile) small for gestational age=602. We identified 9 small for gestational age subgroups: "no main condition detected" (29.0%); "previous low birthweight or preterm birth" (14.6%); "severe maternal disease" (12.0%); "maternal short stature" (11.6%); "hypertensive disorders" (9.6%); "extrauterine infection" (6.8%); "previous miscarriage(s)" (6.5%); "smoking" (5.2%); and "maternal undernutrition" (4.7%). Severe small for gestational age newborns in the "severe maternal disease" (odds ratio, 3.2; 95% confidence interval, 1.8-6.0), "previous low birthweight or preterm birth" (odds ratio, 2.8; 95% confidence interval, 1.6-4.8), and "smoking" (odds ratio, 5.4; 95% confidence interval, 1.3-21.8) subgroups had increased risk of neonatal and long-term morbidity and low anthropometric measures at age 2 as compared to the non-small for gestational age group. Moderate small for gestational age newborns in the "hypertensive disorders" subgroup had increased risk of neonatal morbidity (odds ratio, 2.6; 95% confidence interval, 1.5-4.6) and higher odds of scoring <10th centile of normative values in language (odds ratio, 3.5; 95% confidence interval, 1.0-12.0) and positive behavior (odds ratio, 2.2; 95% confidence interval, 1.1-4.5). The "severe maternal disease" subgroup had also higher risk of deficit (<10th centile of normative values) in language (odds ratio, 5.7; 95% confidence interval, 1.3-24.8) and positive behavior (odds ratio, 3.4; 95% confidence interval, 1.5-7.6). CONCLUSION: Small for gestational age comprises heterogeneous subgroups with distinct patterns of neonatal morbidity, postnatal growth, and neurodevelopmental outcomes up to age 2
EDTA tubes are suitable for insulin and C-peptide measurement in resource-limited settings and can be stored at room temperature for up to 24 hours.
Get PDFINTRODUCTION: Insulin and C-peptide assessment are important in characterization and management of diabetes. However, their adoption and increased clinical use in low resource settings (LRSs) is partly hindered by logistical factors including supplies required for pre-analytical sample handling and limited infrastructure. We aimed to determine the effects of altered sample processing conditions on stability of insulin and C-peptide at the pre-analytical stage. METHODS: Random (non-fasted) blood samples were drawn from ten healthy (glucose range 4.1-8.0 mmol/L) participants. We investigated the mean % change from baseline of C-peptide and insulin in serum (plain tubes) vs plasma (K2EDTA tubes), centrifuged vs uncentrifuged, room vs cool box temperature on the stability of C-peptide and insulin up to 24 hours using Wilcoxon signed rank test. Results were considered clinically significant if the percentage change was > 10% and if the p-value was < 0.05. RESULTS: Eight patients were included in the final analysis, while two were excluded due to hemolysis. C-peptide and insulin levels stayed above 90% of the baseline concentration in K2EDTA tubes across all storage and processing conditions for up to 24 hours. In contrast, samples collected in plain serum tubes kept at room temperature and uncentrifuged, C-peptide and insulin levels decreased significantly to 51% (p = 0.006) and 62% (p = 0. 083) respectively, similarly insulin levels for centrifuged samples declined to 64% (p = 0.083). All iced and centrifuged serum samples remained above 90% of baseline concentration. CONCLUSIONS: In resource-limited settings where insulin and C-peptide tests are limited to central laboratories and highly dependent on sample referral systems, these tests can be reliably measured without the need for immediate centrifugation or processing from samples collected in whole blood K2EDTA tubes uncentrifuged kept at room temperature and processed within 24hours
Exploring the Interplay of Social and Physical Factors in Risk Dynamics and Transitions Across the Life-Course of Female Sex Workers in Blantyre, Malawi: A Longitudinal Narrative Study.
Get PDFSexual risk amongst female sex workers (FSW) varies across the life-course and is influenced by socio-economic and interpersonal factors that affect behavioural choices and engagement in HIV/STI care. We explored transitions in the life-course of FSW to understand the dynamics of sexual risk in Blantyre, Malawi. We implemented a nested longitudinal qualitative study as part of the AMETHIST Consortium, a study testing approaches to reduce HIV transmission in sex work. We conducted consecutive narrative interviews with 30 FSW at three-time points over 12 months, with a three- to four-month break between each time point. We compared narratives to understand sex work transitions, HIV risk and engagement with HIV services. We identified factors (social and physical) related to sexual risk at the points of (1) transitions into sex work, (2) continuing sex work, and (3) breaks in sex work. At the entry stage, sexual risk was heightened when women lacked the knowledge and skills for protection against HIV/STI. Whilst continuing sex work, women's immediate financial needs were prioritised over their HIV/STI risk. These behaviours occurred whether they were aware of the associated HIV/STI risk. During breaks, women perceived lower risk and reduced engagement in prevention strategies, particularly when they had stable partners, which paradoxically increased their risk. These narratives reveal how social context informs and limits access to health care while concurrently promoting risky behaviours. A multifaceted and dynamically responsive approach that considers risk differentiation from a temporal perspective can strengthen targeted interventions, effectively addressing the multiple challenges faced by FSW
Prevalence of Ocular Chlamydia trachomatis and Active Trachoma among Children in Merhabete District, Amhara, Ethiopia
Get PDFABSTRACT.
There have been significant reductions in the burden of trachoma worldwide. However, some districts have experienced persistently high trachoma prevalence despite many years of intervention. Here, we report the epidemiology of trachoma in Merhabete, Ethiopia, a district in the Amhara Region that has been receiving azithromycin mass drug administration (MDA) since 2009. Data were obtained from the baseline survey of a cluster randomized trial evaluating targeted treatment strategies for trachoma elimination. An enumerative census was conducted in February 2022 to generate lists of children aged 6 months to 9 years in 80 sentinel communities participating in the trial. All children in the sentinel communities who were included in the census were examined. Field grades and conjunctival swabs were collected to assess active trachoma (based on clinical assessment) and ocular chlamydia (based on polymerase chain reaction to identify Chlamydia trachomatis). A total of 5,935 children were examined in 80 communities. The prevalence of trachomatous inflammation—follicular (TF) was 46.6%, trachomatous inflammation—intense (TI) was 17.5%, and ocular chlamydia was 28.0%. The correlation between TF and ocular chlamydia (correlation coefficient 0.54, 95% CI 0.34–0.70) was similar to the correlation between TI and ocular chlamydia (correlation coefficient 0.49, 95% CI 0.30–0.65). The prevalence of ocular chlamydia remained high in this district, which had received more than 10 rounds of azithromycin MDA. Ocular chlamydia was moderately correlated with both TF and TI. Intensive interventions may be required to eliminate trachoma in settings with persistently high ocular chlamydia prevalence despite many years of intervention
Diet cost and affordability metrics, their application today and in the future
Get PDFEnsuring that all people can afford a healthy, nutritious diet is a prerequisite for ensuring food security and ending malnutrition. Diet cost and affordability metrics are useful for revealing the systemic barriers people face in consuming an adequate diet. This seven-article special issue brings together insights and analyses from the application of these metrics in the World Food Programme’s Fill the Nutrient Gap (FNG). The FNG is an analytical process that captures subnational and intra-household variation in the cost and affordability of diets that meet health and nutrition needs (Bose et al). The FNG sheds light on the heightened vulnerabilities of groups such as adolescent girls, people living in fragile food environments, and those far from the threshold of being able to afford a nutritious diet (Bose et al). Standardized data from Fill the Nutrient Gap analyses in 37 countries has also been gathered and made available through FNGSTAT, an open access dataset (see Klemm, Turowska et al and Turowska et al, this issue)
Behind closed doors: Public and private views on child domestic work in urban Myanmar
Get PDFBackground: There has been little evidence on how public perceptions of child domestic work influence work conditions, employment and living arrangements for young workers. Objective: This study in urban Myanmar explores public views and attitudes on child domestic work to consider the implicit and explicit work arrangements between households and child domestic workers. Participants and Setting: We conducted a cross-sectional survey with 1072 adult participants from Yangon and Mandalay urban townships. Methods: We analysed attitudes estimates toward child domestic work among different subgroups. We conducted bivariable and multivariable regressions to examine factors associated with perceptions about responsibilities of host households towards child domestic workers in urban Myanmar. Results: Sixty per cent of study participants reported knowing households with child domestic workers. When asked about working conditions, most participants stated that they themselves endorsed aspects of safe, decent work and young workers’ engagement in education and training, but suggested that community beliefs are much less liberal. Many participants believed that child domestic workers are subjected to harmful conditions, including that these children are not likely to participate in educational activities, receive holiday breaks, or have their safety and well-being prioritized. These beliefs were associated with: older age (≥30 years), being female, belonging to the host household, having awareness of child domestic work, having higher education, and having a lower household income. Conclusion: Our findings underscore the need to promote child-centred work and private work arrangements, combined with interventions that foster the safety, well-being and promising futures for youth in domestic work situations
Assessing the effect of a Massive Open Online Course (MOOC) on school water, sanitation, and hygiene improvements in the Philippines
Get PDFImproving water, sanitation, and hygiene (WASH) services in low-resources settings is a challenge. The Department of Education (DepEd) of the Philippines, supported by GIZ and UNICEF, runs the national WASH in Schools (WinS) program which promotes a stepwise approach to reach national WinS standards and foster the institutionalisation of WASH in the education sector. This includes national-level annual monitoring on WASH service levels in schools, information used to set targets and allocate resources. Since 2019, the programme has also included a Massive Open Online Course (MOOC) for school staff. This platform provides uniform implementation guidance on WinS in schools across the country. In this analysis, we use annual WASH monitoring data from 2017/2018 (baseline) and 2021/2022 (endline) and compare this against school-level information on MOOC enrolment and completion. We used logistic regression models to assess the relationship between school staff participation in the MOOC and changes in select WinS indicators as well as composite measures used to define national progress. Complete baseline and endline data were available for 27,795 schools. Of those, 5,939 schools had at least 1 teacher enrolled in the MOOC. Overall, MOOC participation was associated with improvements in school infrastructure, maintenance of existing facilities, and promotion of hygiene programmes. The MOOC is a promising key component of the national WASH strategy complementing the annual monitoring process and warrants further investigation in the school management sector
Interobserver Variability in Cardiovascular FDG PET/CT Analysis in Large Vessel Vasculitis.
Get PDFINTRODUCTION: PET/CT has a synergistic value for optimal diagnosis, disease activity monitoring, and evaluation of damage progression in large vessel vasculitis. The use of standardized uptake values (SUV) as a measurement of relative tissue uptake facilitates comparisons between patients, and has been suggested as a basis for diagnosis. The SUVmean and SUVmax reproducibility in vascular structures is not widely studied. OBJECTIVE: The objective of this study was to evaluate the inter-observer variability of both qualitative visual grading of aortic 18F-FDG uptake and the quantitative aortic mean and maximum SUVs in these patients with mild to moderate covid-19 infection who underwent multimodality cardiac imaging within the COSMIC-19 trial. STUDY DESIGN: This is a sub-study of the COSMIC-19 trial. 30 patients were subjected to a combined Computed Tomography Coronary Angiogram and 18F-FDG PET/CT, followed by cardiac magnetic resonance. Two independent observers measured the Standardized uptake values in five regions of interest at each aortic segment. These were performed sequentially along the length of the aorta every 5 mm on the axial slices. The maximum and mean standard uptake values were measured. RESULTS: Qualitative assessment showed excellent agreement between observer x and y for the ascending aorta and aortic arch regions with the kappa coefficients for the inter observer agreement of 0.92 (95% CI:0.78-1.0) and 0.91 (95% CI:0.74-1.0) respectively. Quantitative assessment showed a very high positive correlation between the two observers for each of the regions measured for SUVmean as follows; ascending aorta r = 0.96 (p < 0.001), Aortic arch r = 0.90 (p < 0.001) and descending Aorta r = 0.91 (p < 0.001). The correlation coefficients for the SUVmax were substantially strong. CONCLUSION: This study shows an excellent inter-observer reproducibility for both qualitative and quantitative SUVmean vascular 18F-FDG measurements in patients with COVID-19 large vessel vasculitis. Quantitative SUVmax demonstrated substantially strong interobserver reproducibility
The ahpC c-54t compensatory mutation is not always a valid surrogate for isoniazid resistance in Mycobacterium tuberculosis.
Get PDFThirteen commercial genotypic antimicrobial susceptibility assays interrogate mutations upstream of ahpC to infer isoniazid resistance for Mycobacterium tuberculosis. We demonstrate that relying on one of these compensatory mutations (i.e., ahpC c-54t)-rather than causative resistance mutations in katG that ahpC compensates for-can result in systematic false-resistant results for isoniazid with the Cepheid Xpert MTB/XDR and suboptimal treatment. The WHO mutation catalog should be refined to address this scenario